Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chemical Agents of Opportunity for Terrorism
Training Support Package
Participant Guide
Slide 5
Chemical Agents of Opportunity for Terrorism:
TICs & TIMs
Thallium Poisoning
• Classic Triad:
– Gastrointestinal distress (N/ V/ D) within a few hours, mild
– Painful polyneuropathy (severe pain in the extremities)
• About 24 hours after exposure, dose dependent
– Hair loss; usually 2(+) weeks after exposure
– Other: constipation, hypertension, EKG changes
• Diagnostic testing
– Abdominal x -rays may show metal
– Blood thallium > 100 µg/L, urine thallium greater than 200 µg/L
considered toxic
Module One - Terrorism by Fear and Uncertainty: Delayed Toxic Syndromes
5
The “classic triad” of thallium poisoning is gastrointestinal symptoms, followed in a day
or two by very painful distal extremities (especially soles of the feet), and after a delay of
another 1-2 weeks, hair loss (alopecia). A history of recent severe nausea, vomiting,
and diarrhea is an important clue to thallium (or arsenic) in patients who present with
acute painful neuropathy and/or progressive diffuse hair loss.
Thallium is a metal; therefore it may appear as a radiopaque density on an x-ray of the
abdomen. However, from a practical point of view, patients rarely present early enough
for this to be a useful diagnostic tool..
Blood thallium can be measured in reference laboratories. The test is not available in
most hospital labs.
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